Digital Commons Network^™

Searching For Phenotypes Of Sepsis: An Application Of Machine Learning To Electronic Health Records, Michael Jarvis Boyle

Yale Medicine Thesis Digital Library

SEARCHING FOR PHENOTYPES OF SEPSIS: AN APPLICATION OF MACHINE LEARNING TO ELECTRONIC HEALTH RECORDS. Michael J. Boyle (Sponsored by R. Andrew Taylor). Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT.

Sepsis has historically been categorized into discrete subsets based on expert consensus-driven definitions, but there is evidence to suggest it would be better described as a continuum. The goal of this study was to perform an exhaustive search for distinct phenotypes of sepsis using various unsupervised machine learning techniques applied to the electronic health record (EHR) data of 41,843 Yale New Haven Health System emergency department …

Development Of A Standardized Oral Care Staff Education Program, Katrina Detoye

Walden Dissertations and Doctoral Studies

Hospital-acquired infections such as nonventilated hospital-acquired pneumonia (NV-HAP) are significant patient safety concerns. The lack of oral care in the nonventilated acute care patient population is a major contributor to NV-HAP. Nursing staff are on the frontline in the provision of oral care to hospitalized patients, but a lack of knowledge regarding the relationship between oral care and NV-HAP was identified as a gap in practice at the project site. The purpose of the project was to develop a staff education program on oral care of the nonventilated patient population. The practice-focused question addressed whether an evidence-based education for nurses …

Staff Education Program On Diabetes Using Self-Care Behaviors, Ruth Adhiambo Ogot

Walden Dissertations and Doctoral Studies

Type 2 diabetes mellitus affects patients' health across the globe and is costly to manage. The chronic high blood sugar of diabetes is linked to cardiovascular and kidney damage, impaired functional status, and multiple organ failure. To lessen the complications associated with diabetes and promote self-care in those with the disease, health care professionals must be vigilant in offering diabetes education to patients with each clinic or primary care visit. Lack of diabetic educators in the clinic that provided the setting for this study indicated a need to increase clinical staff competency in teaching self-care and diabetes management to patients. …

Pull And Push Factors That Influence A Student's Decision To Drop Out Of School, Monica Ruth Rouse

Walden Dissertations and Doctoral Studies

The high school dropout rate in the United States has historically been and continues to remain a persistent concern. The dropout epidemic has primarily been studied through a quantitative lens focused on the final decision to dropout rather than the complex sequence of events that factor into the dropout decision. The purpose of this study was to explore the pull/push factors that influenced a student's decision to drop out of high school. In this qualitative study, attention was given to both understanding how students described their reasons for dropping out of school and identification of any factors that could have …

Strategies For Patient Engagement In A Self-Management Program For Adults With Diabetes, Carolinee Jokotola Ogungbayi

Walden Dissertations and Doctoral Studies

Patients' lack of adherence to diabetes self-management education and support (DSMES) recommendations is a challenge for healthcare. One approach to addressing patient noncompliance with DSMES is through education of staff on current guidelines. In an outpatient facility in South Texas, staff training on current DSMES guidelines was recommended as one of the solutions to the problem of Type 2 diabetes mellitus (T2DM) complications observed among clinic patients. An educational module was created to increase staff knowledge on T2DM and to assist staff members in teaching patients to self-manage T2DM. The module was built on the self-management and health promotion models, …

An Educational Program To Reduce Surgical Site Infection In Vascular Patients, Karen Driskill

Walden Dissertations and Doctoral Studies

Surgical site infections (SSIs) are a leading cause of morbidity and mortality in the United States. Researchers have demonstrated the impact that SSIs have on the healthcare system and the need to improve patient outcomes. The purpose of this project was to develop an educational program for the 8-member nursing staff of an outpatient vascular surgical office to help reduce the occurrence of SSI rates for patients seen pre and postoperatively after a noted increase in SSI rates at this clinical setting. Guided by the Fitzpatrick model, a group of 6 health care providers comprising 3 surgeons and 3 nurse …

Workplace Isolation Occurring In Remote Workers, Adam Hickman

Walden Dissertations and Doctoral Studies

Organizational leaders and managers may not have the management acumen, organizational awareness, or leadership expertise to construct and implement effective strategies, policies, and procedures to help reduce the frequency of the phenomenon of workplace isolation. The purpose of this qualitative, exploratory, multiple case study was to gain a common understanding about how workplace isolation may influence a remote employee'€™s performance in a customer service organization in the United States. Emerson'€™s social exchange theory was used as the conceptual framework. A series of semistructured interviews with 21 remote workers that consisted of four different divisions at the same organization was conducted …

Fostering Self-Care And Nurse Resilience, Cheryl Jean Mcnamara

Walden Dissertations and Doctoral Studies

Role expectations and stressful work environments place nurses at high risk for burnout. Nurses at an urban hospital were experiencing unhealthy work environments and not engaging in self-care to promote health and wellbeing. The purpose of this project was to evaluate the effectiveness of an existing quality improvement (QI) initiative developed to encourage nurses to engage in self-care. Pender'€™s health promotion model supported the premise that despite barriers, nurses will engage in self-care. A survey elicited responses from 1,248 participating registered nurses on the extent of their engagement with self-care and perceived effect on their health, health knowledge, stress level, …

Cultural Factors Affecting African Americans Of Caribbean Descent With Type Ii Diabetes, Ruth Runette Aguy-Paulsaint

Walden Dissertations and Doctoral Studies

Type II diabetes is a significant problem in the United States that had affected almost 10% of the American population and over 13% of African Americans. Although culturally competent diabetes education and treatment programs have been significantly more successful, little is known about the cultural factors affecting type II diabetes in African Americans of Caribbean descent (AACD). The purpose of this qualitative, phenomenological study was to explore the cultural factors relevant to the treatment and prevention of type II diabetes among AACD. The theoretical framework for the study consisted of cultural adaptation theory and the transtheoretical model. Data collection consisted …

Adult Character Strength Use And Its Relationship To Physical And Mental Health, Angela Beth Bergen

Walden Dissertations and Doctoral Studies

In this study, the use of human character strengths was evaluated as a component of mental and physical health. The majority of previous character strengths research has been limited to monotonic use of character strengths. This study evaluated subjective outcomes based on a new measure of how much adults reported underusing, optimally using, and overusing their character strengths. This exploratory study was theoretically grounded in the upward spiral model of lifestyle change. The underuse, optimal use, and overuse of character strengths were evaluated as predictors of physical and mental health status, health behaviors, and emotions. Using a convenience sample of …

Perceptions Of Access To Healthcare In Cameroon By Women Of Childbearing Age, Wenceslaw Chap Chapnkem

Walden Dissertations and Doctoral Studies

Increased poverty and unemployment rates, minimal investment in social amenities, a shortage of healthcare professionals, poor infrastructure, inadequate social services, and poor institutional and political leadership have weakened the healthcare status of Cameroon's women who have reached the age of childbearing. The World Health Organization expressed increased urgency for healthcare providers and patients to develop new healthcare policies to eliminate health-related disparities. The aim of this phenomenological study was to examine the perceptions of women of childbearing age living in Mamfe rural community in regard to Cameroon's healthcare system and its impact on their lives. The theoretical foundation of the …

Middle School Teachers' And Administrators' Experiences When Students Transition, Thomas L. Jones

Walden Dissertations and Doctoral Studies

Student discipline and subsequent placements are a common problem in education. This qualitative phenomenological study addressed a gap in the literature by discovering the experiences of middle school teachers and administrators regarding student discipline, classroom removal, and assignment of students to alternative education. This research describes the development of an interview protocol based on critical incident theory and demonstrates its usage in drawing out thick, rich descriptions which help increase the trustworthiness of qualitative research. Initial interview data are presented to highlight the utilization of critical incident theory to elicit specific information about how participants experienced various critical interactions that …

The Reproductive Health Needs Of Women At Risk Of Hiv Infection In Connecticut, Emily Hoff

Yale Medicine Thesis Digital Library

Background: The number of women involved in criminal justice systems (WICJ) and women who use opioids has been dramatically increasing in the United States. An often-overlooked aspect of healthcare for women at risk of HIV infection (either WICJ or women who use drugs) is reproductive health. We aim to provide a framework, informed by a systematic review and primary data, to guide future interventions addressing the sexual and reproductive health (SRH) needs of women at risk of HIV infection.

Methods: We completed a systematic literature review of the pregnancy prevention and planning needs of US WICJ published in English from …

Small Food Stores Assessment In Low Income Low Access Communities In Providence, Rhode Island, Yuyao Huang

Open Access Master's Theses

Inventory requirements for authorized Supplemental Nutrition Assistance Program (SNAP) retailers have undergone several revisions to increase the availability of healthful foods. A proposed rule of 84 staple food items was not implemented due to concerns that stores would not withstand this expansion, resulting in a final rule requiring 36 items. This study used the Food Access Research Atlas data to characterize food provisions in 30 small retailers in areas with high and low proportion of SNAP and racial minority residents in Providence, RI. Stores were assessed with an audit instrument to tally variety, perishability and depth of stock of four …

The New State Preemption, The Future Of Home Rule, And The Illinois Experience, Nestor M. Davidson, Laurie Reynolds

Faculty Scholarship

This article examines the rise of new forms of state preemption of local government legal authority in states across the nation, a trend that is prompting scholars, advocates, and officials to re-examine the underlying nature of home rule. The article lays out core components of a new approach to home rule that might remedy contemporary shortcomings in the doctrine, then reflects on lessons for reforming home rule from the Illinois experience.

The Stakeholder Gap Lens: Teacher And Parental Perceptions Of The Achievement Gap In Kentucky's Public Schools, Heather Renee Brown Chapman

Theses and Dissertations--Science, Technology, Engineering, and Mathematics (STEM) Education

The research around the achievement gap is extensive. However, regardless that the term “achievement gap” is so widely used in academia today, there is often confusion surrounding what the achievement gap is. This study seeks to answer three research questions: (1) To what extent does an achievement gap exist among different subgroups of students in Kentucky’s K-12 public schools? (2) How do the perceptions of parents and teachers interact with decision-making? (3) How do the ideas of parents and teachers regarding closing the achievement gap compare?

This research examines perceptions of the existence of an achievement gap in Kentucky’s public …

Factors That Influence Maternal Feeding Decisions For Toddlers: Extending The Theory Of Planned Behavior, Elizabeth Lucas Combs

Theses and Dissertations--Kinesiology and Health Promotion

Establishing healthy eating behaviors is vital in the early years to help combat the development of obesity and other chronic diseases. Mothers play an invaluable role in shaping their children's eating habits through controlling what and when children eat as well as the overall food environment, which is why a better understanding of what influences mothers’ decisions about these behaviors is important.

The purpose of the dissertation was to gain a better understanding of what impacts maternal feeding decisions regarding toddler nutrition behaviors. This was a two-phased mixed methods study. The aim of the initial study was to explore, using …

The Effects Of The Usda Summer Food Service Program On Rural Adolescents’ Nutrition Attitudes, Knowledge, Behavioral Intentions And Nutrition Behaviors, Mary Rachel Harrington

Theses and Dissertations--Kinesiology and Health Promotion

Rural adolescents suffer from poor nutrition, increasing their risk for obesity and other chronic diseases. The Summer Food Service Program (SFSP), an off-shoot of the National School Lunch Program, provides meals to qualifying children, including low-income, rural adolescents, under the age of 18. The purpose of this study was to: 1) examine the impact of the SFSP on the nutrition–related knowledge, self-reported fruit and vegetable (SRFV) consumption, and the constructs of the Theory of Planned Behavior (attitudes, subjective norms, perceived behavioral control, and behavioral intentions) of rural, low-income adolescents; and 2) examine the relationship between nutrition behaviors (quality food selection …

Chronic Low Intensity Continuous And Interval Training Prevent Heart Failure-Related Coronary Artery Stiffness, An Ouyang

Theses and Dissertations--Kinesiology and Health Promotion

Heart failure (HF) induced by aortic pressure over-load is associated with increased coronary artery stiffness. Perivascular adipose tissue (PVAT) and advanced glycation end products (AGE) both promote arterial stiffness. However, the mechanisms by which coronary PVAT promotes arterial stiffness and the efficacy of exercise to prevent coronary stiffness are unknown. The present study hypothesized both chronic continuous and interval exercise training would prevent coronary artery stiffness associated with inhibition of PVAT secreted AGE. Yucatan mininature swine were divided into four groups: control-sedentary (CON), aortic-banded sedentary heart failure (HF), aortic-banded HF continuous exercise trained (HF+CONT), and aortic-banded HF interval exercise trained …

The Effects Of Curcumin And Fenugreek Soluble Fiber On The Physical Working Capacity At The Fatigue Threshold, Peak Oxygen Consumption, And Time To Exhaustion, Lauren Herrick

Theses and Dissertations--Kinesiology and Health Promotion

Curcumin, a polyphenol, has been suggested to improve metabolic byproduct clearance and increase nitric oxide production in working muscle. These purported effects may delay neuromuscular fatigue. Therefore, the purpose of this study was to examine the effects of curcumin in combination with fenugreek (CUR) or fenugreek soluble fiber alone (FEN) on the neuromuscular fatigue threshold (PWC_FT), time to exhaustion (T_lim) on a graded exercise test (GXT), and O₂peak in untrained subjects.Forty-seven,college-aged, aerobically untrained individuals were randomly assigned to one of three supplementation groups; placebo (PLA, n=15),curcumin + fenugreek, CurQfen® (CUR, n=18), or fenugreek soluble …

Effects Of Curcumin And Fenugreek Soluble Fiber Supplements On Submaximal And Maximal Aerobic Performance Indices In Untrained College-Aged Subjects, Jensen Goh Zhong Sheng

Theses and Dissertations--Kinesiology and Health Promotion

Submaximal exercise performance is, in part, limited by the accumulation of metabolic byproducts and energy system capacities. Curcumin and the combination of curcumin and fenugreek soluble fiber (CurQfen^®) have been shown to increase endogenous antioxidants and metabolic byproduct clearance as well as reduce inflammation and lipid peroxidation, and therefore, may enhance submaximal aerobic thresholds. In addition, there is evidence that the galactomannan component of fenugreek, used to enhance bioavailability of curcumin, may also have potential physiological effects related to the up regulation of free fatty acid oxidation Therefore, the purpose of this study was to examine the effects …

The Effect Of Increased Physical Activity On Academic Performance, Lauren Michelle Willis

Theses and Dissertations--Education Sciences

Increased levels of obesity, particularly among American youth, have consistently been cause for concern over the last few decades. Additionally, the amount of time youth spend being active throughout the day has consistently decreased. Physical activity levels among school-aged children in America are effected by any number of reasons, but this study points to the possibility of time spent being physically active during the school day having the greatest effect on a student’s overall level of physical activity. Increased pressures from different entities on local schools to improve student performance on standardized test scores have contributed to a decline in …

Noninvasive Multimodal Diffuse Optical Imaging Of Vulnerable Tissue Hemodynamics, Mingjun Zhao

Theses and Dissertations--Biomedical Engineering

Measurement of tissue hemodynamics provides vital information for the assessment of tissue viability. This thesis reports three noninvasive near-infrared diffuse optical systems for spectroscopic measurements and tomographic imaging of tissue hemodynamics in vulnerable tissues with the goal of disease diagnosis and treatment monitoring. A hybrid near-infrared spectroscopy/diffuse correlation spectroscopy (NIRS/DCS) instrument with a contact fiber-optic probe was developed and utilized for simultaneous and continuous monitoring of blood flow (BF), blood oxygenation, and oxidative metabolism in exercising gastrocnemius. Results measured by the hybrid NIRS/DCS instrument in 37 subjects (mean age: 67 ± 6) indicated that vitamin D supplement plus aerobic training …

Biological Selenium Control: Selenium Reduction By Shigella Fergusonii Strain Tb42616 And Pantoea Vagans Strain Ewb32213-2 In Bioreactor Systems, Yuxia Ji

Theses and Dissertations--Civil Engineering

Se(VI) and Se(IV), as the two major species of selenium in water, are toxic to aquatic lives and may cause adverse health effects to humans at high levels. Biological reduction of Se(VI) is a two-stage process first from Se(VI) to Se(IV) and then from Se(IV) to Se(0) with potential accumulation of the more toxic Se(IV) due to the slower rate of the second stage.

Selenium reduction was first evaluated with batch cultures of Shigella fergusonii strain TB42616 (TB) and Pantoea vagans strain EWB32213-2 (EWB) isolated in our laboratory from sludge and coal slurry sediment samples, respectively. In order to facilitate …

The Role Of Place In Community Cooperative Food Markets In Lexington, Kentucky, Emily Rodes Spencer

Theses and Dissertations--Community & Leadership Development

Food justice movements focus on providing communities with local, sustainable, culturally appropriate, healthy food while empowering local economic systems that allow for autonomy of both producers and consumers (Caruso, C., 2014; Cadieux, K., 2015; Hayes, C. & Carbone, E., 2015). However, current food justice movements often price out and leave behind large portions of the population. Research has shown that engagement with local food systems contribute to feelings of place attachment and a sense of place (Solin, J., 2017; Alkon, A., 2011). The purpose of this study was to explore the relationship between volunteers at two alternative, cooperative community food …

Evaluation Of Air Movement In Equestrian Facilities And On Equine Athletes, Staci Elaine Mcgill

Theses and Dissertations--Biosystems and Agricultural Engineering

Ventilation and air movement are important aspects of animal agriculture and is frequently neglected in equine facilities. This paper discusses three different studies that examine different components of ventilation and air movement. One is a fan orientation study which examines how fans impact the stall environment, the second is a cooling study questioning whether forced air speed across a horse increases the rate of cool out after intense exercise, and the last is a survey examining ventilation, air quality, and health concerns in indoor arenas.

The stall fan study took place over two summers with the goal of determining how …

Essays On Child Well-Being And The Social Safety Net, Cody N. Vaughn

Theses and Dissertations--Economics

This dissertation consists of three essays examining the role of two particular social safety net programs, the Temporary Assistance for Needy Families (TANF) program and the Supplemental Nutrition Assistance Program (SNAP), on the well-being of children from disadvantaged households. While the impact of these programs on the adults and parents of the household have been studied extensively, less is known about their effect on children. This is true for both their immediate impact on child well-being and any long-run impacts on children who grow up under these programs. Given the demonstrated importance of child well-being on later life adult outcomes, …

A Lifestyle Intervention To Decrease Risk Of Developing Type 2 Diabetes Mellitus In A Rural Population, Amanda Culp-Roche

Theses and Dissertations--Nursing

Individuals with type 2 diabetes mellitus (T2DM) are at risk for developing life-threatening comorbidities such as cardiovascular disease (CVD). As a consequence, T2DM is associated with increased morbidity and mortality and decreased quality of life, thus highlighting the importance of prevention of T2DM. Further, the prevalence of T2DM is substantially greater in rural populations compared to urban populations, making rural individuals particularly appropriate targets for T2DM prevention.

T2DM is a largely preventable disease that is associated with modifiable risk factors such as poor diet, sedentary lifestyle, and obesity. Lifestyle interventions to improve these modifiable risk factors have been used to …

Frailty In Patients Undergoing Left Ventricular Assist Device Implantation, Candice Falls

Theses and Dissertations--Nursing

Heart failure is a progressive condition that affects over 5.7 million Americans and costs associated with heart failure account for 2-3 % of the national health care budget. The high rates of morbidity and mortality along with increased costs from readmissions associated with advanced heart failure have led to the exploration of advanced treatments such as left ventricular assist devices (LVADs). LVADS have demonstrated morbidity and mortality benefit but cost remains extensive with costs per quality-adjusted years > $400,000. With this in mind, it is important to identify those who are most likely to benefit from an LVAD to avoid unfavorable …

The Impact Of Maternal Nutrition During Pregnancy On Inflammation And Birth Outcomes, Lori Ogden

Theses and Dissertations--Nursing

More than 85% of American adults do not consume recommended amounts of fruits or vegetables. Preterm birth and hypertensive disorders of pregnancy are common adverse conditions affecting pregnancy and are leading causes of maternal and fetal morbidity and mortality. Preterm birth affects nearly 10% of all births in the United States and is on the rise, as are hypertensive disorders, which have increased by 25% over the last two decades. Pregnancy is a state of controlled inflammation, and dysregulation has been linked to preterm birth and other adverse gestational outcomes. A healthy diet is recommended in pregnancy, but little is …